DamnYankees:I've acknowledged that - I'll do it again here: it appears the ACA does not protect people against this particular aspect of medical costs.

But it does, indirectly. Like I said above, the reasons for balance billing is that hospitals are under-compensated for some people, so they need to overcharge others. The ACA 1) reduces the number of uninsured people, meaning that there will be fewer instances of ER visits without the ability to pay at all, 2) requires insurance companies to at least pay hospitals what they would pay in-network ERs, so not only are hospitals seeing more covered patients, but being paid more on average per patient, so 3) in general the practice of balance billing should be reduced since hospitals are being more well compensated, and 4) it helps individuals since their insurance has to pay for the equivalent of in-network hospitals even at out-of-network ERs, so even emergency visits will be less expensive for individuals, which are generally the most expensive medical bills.

Serious Black:ObamaCare did do a lot on the cost control front. ACOs, the IPAB, the Center for Medicare/Medicaid Innovation, the PCORI, the co-op insurance program, the Cadillac excise tax, the minimum medical loss ratio rules...these all will have some impact on costs.

Do you have any hard numbers on this? I know there have been a lot of proposed measures and additional bureaucracy and regulations that ideally might in some way produce some potential savings, but the numbers I have seen from the CBO show us paying more than if we had done nothing and predicting rising healthcare costs per capita over the next decade or more. I have not seen any hard numbers showing a net reduction in either insurance premiums or health care costs, and minimal, if any, reduction in the RATE of growth. But I may have missed some key information.

I assume you have looked into it. What have you found that convinces you otherwise?

DamnYankees:BojanglesPaladin: So just to be clear, Obama and the ACA advocates and proxies, when discussing the ways that ACA was needed top protect Americans from bankruptcy, they meant "except for when the crippling bankruptcy inducing bills are a result of out-of-network billing".

Got it.

I'm not sure what you want me to say to this. It's a hole that needs to be fixed. Let's fix it. Do you want me to rend my garments over the fact that ACA is not a perfect bill, and that the people that drafted and supported it couldn't imagine every future scenario which might escape its coverage?

Of course that's what he wants. It would be a nice touch if you set them on fire as well, all the while begging your goper betters for forgiveness.

bradkanus:queezyweezel: bradkanus: BKITU: bradkanus: It seems like a lot of people who cheered on the law because they are partisan before they are anything else, are now backpeddling on the law.

Today, in "Morons Seeing What They Want To See Theater"....

Feel a little guilty, don't you? It's okay - you didn't read the bill. You took their word for it. You were told by the people you voted for it was one thing. It turned out to be another.

Hey, that whole "weapons of mass destruction" thing really killed me. I believed it because the guys I voted for told me it was so. They were wrong. I learned a lesson. Will you learn yours?

I think most rational people were happy that it passed because it's a step in the right direction. Most people knew it wasn't perfect, and in general wasn't really great in any sense of the word. What it is, is a pivot point towards a single payer system, and serious reform of the current billing/coverage rules.

Do you really look at issues that simplistically? derp derp derp?

And here's where you are 100 percent wrong. It was a step away from single payer in every since of the ideal. It put more Americans into a private system and took them out of the public system. If you think that's a step toward single payer, you're not familiar with how single payer works.

Also, the problems with the government handling the IT portion of the health exchanges has been the evidence to liberals in power that they are not ready to take on the kind of task a single payer system would be. This system was supposed to handle 35 millino people and literally work as a pass through to insurance companies. It was a hallway, so to speak. They failed at that. They now know that single payer is not an option because they can't create the infrastructure to make it succesful.

Yeah it's not like they've gotten Medicare or Social Security to work at all, those aren't very big. No one is saying things are perfect but this argument is just garbage. The issue here <conspiracy hat on> is that the government has had to interface with hundreds or thousands of private providers who frankly don't have much incentive to be on top of their game. I'm sure NONE of them sandbagged testing or just outright told the builders "yeah it's working fine" when it wasn't. I mean after all, who's going to be in the news when that bug shows up in prod, Joe's discount healthcare or the big old federal government.

This is going to follow the same trajectory as gay marriage. Right now we're in the "People will be able to marry turtles!" phase. But mark my words, those of you that fight universal healthcare are going to find yourselves on the wrong side of history, AGAIN for many of you.

My hope is that it occurs in your lifetime so you have to live through some of it, like that girl that was screaming at the black kids trying to walk to school after desegregation. She has to live with that every day, more so on anniversaries when she gets interview requests (just saw one last year). Let that sink in for a minute before you regurgitate your stale talking points again.

DamnYankees:Obviously Democrats should be in favor of somehow fixing this, and those who are not would, in my opinion, be wrong to oppose it.

My issue is that they are simply uninterested in fixing what is wrong with it. I think it is safe to say that the Republican's plan is simply to repeal it, and I appreciate that a lot of Americans don't want to see the baby thrown out with the bathwater, even if they now see just how filthy the bathwater is.

But the Democrats SHOULD have a vested interest in making this thing actually work. If for no other reason than political self preservation. But for years now, they have been playing a political game of see no evil, hear no evil on ACA and doing nothing for fear of any attempts to do so being the camel's nose for the Republicans.

And so... nothing. And the dirty little secret that Democrats can't bring themselves to face is that the ACA isn't workable, and it's only going to get worse as it unfolds. And they sold it to America with a lot of slick salesmanship and we all bought it. But it's not exactly working like it said in the brochure and now they are refusing to do the needed warranty work on it.

BojanglesPaladin:DamnYankees: Obviously Democrats should be in favor of somehow fixing this, and those who are not would, in my opinion, be wrong to oppose it.

My issue is that they are simply uninterested in fixing what is wrong with it. I think it is safe to say that the Republican's plan is simply to repeal it, and I appreciate that a lot of Americans don't want to see the baby thrown out with the bathwater, even if they now see just how filthy the bathwater is.

But the Democrats SHOULD have a vested interest in making this thing actually work. If for no other reason than political self preservation. But for years now, they have been playing a political game of see no evil, hear no evil on ACA and doing nothing for fear of any attempts to do so being the camel's nose for the Republicans.

And so... nothing. And the dirty little secret that Democrats can't bring themselves to face is that the ACA isn't workable, and it's only going to get worse as it unfolds. And they sold it to America with a lot of slick salesmanship and we all bought it. But it's not exactly working like it said in the brochure and now they are refusing to do the needed warranty work on it.

bradkanus:coyo: bradkanus: DamnYankees: While the issue in TFA is a problem, it has absolutely nothing to do with Obamacare. It's just a general problem with the medical industry. Should we fix it? Sure. But "Obamacare failed to fix this pre-existing issue which was already broken" isn't much of an argument; Obamacare isn't a panacea.

Not a "panacea?" Uh, then what were you so excited about when it passed? It seems like a lot of people who cheered on the law because they are partisan before they are anything else, are now backpeddling on the law.

You guys said it was good.

It's not.

Move on.

If I remember correctly, we said it was better than what was extant and that single payer is much preferable. I'm amazed at the energy that is spent tearing this down rather than making concrete suggestions on how to improve things. Given the rapid response from people like you, it rather feels like your posts are what pays your bills rather than any real conviction.

But apparently it's not better. It's more expensive and your doctor options more narrow (with good reason). I think you should have read the bill instead of just receiving the talking points.

Says the guy who keeps inserting the same thing into each of his many posts. I'm sure you've read the bill cover to cover, and did so before forming your completely objective opinion, even though the word liberal is pejoratively multiple times, but conservative is nowhere to be found.

BojanglesPaladin:DamnYankees: Obviously Democrats should be in favor of somehow fixing this, and those who are not would, in my opinion, be wrong to oppose it.

My issue is that they are simply uninterested in fixing what is wrong with it. I think it is safe to say that the Republican's plan is simply to repeal it, and I appreciate that a lot of Americans don't want to see the baby thrown out with the bathwater, even if they now see just how filthy the bathwater is.

But the Democrats SHOULD have a vested interest in making this thing actually work. If for no other reason than political self preservation. But for years now, they have been playing a political game of see no evil, hear no evil on ACA and doing nothing for fear of any attempts to do so being the camel's nose for the Republicans.

And so... nothing. And the dirty little secret that Democrats can't bring themselves to face is that the ACA isn't workable, and it's only going to get worse as it unfolds. And they sold it to America with a lot of slick salesmanship and we all bought it. But it's not exactly working like it said in the brochure and now they are refusing to do the needed warranty work on it.

With the current status, the ACA cannot be fixed. The house won't pass anything that actually 'improves' the bill, and the Democrats don't have the seats to force anything through like they did when it passed in the first place. The republicans 'win' by not allowing anything through that would fix it and just sitting back and pointing out the flaws.

When you say 'then pass a bill fixing the flaws', all they have to do is say 'there are too many flaws to fix, we need to repeal and start over'.

12349876:Are hospitals purposefully duping people into thinking all of their care will be in network for some extra cash or do they just not want to anger patients or have patients go elsewhere when no other option is available?

It's intentional for the extra money. I live in AZ but my emergency surgeon (for 6 stitches in my finger) ended up being "based in Oklahoma City" which of course is out of network. I'm lucky that my insurance caps my emergency room very low, so I didn't owe anymore (I was told "Just fax that to us we'll take care of it").

Not informing you that not all doctors on a procedure are in network sounds like fraud. How can I even vet that? Last surgery I had was scheduled by my doctor with no consultation on price. Granted at the time I had a cadillac insurance plan that cover everything at 100% with no deductible, co-pay or monthly premium. I guess this is something I have to worry about now.

I do not specify. All are welcome to respond in the manner they see fit.

But perhaps you should acquaint yourself with concepts like "Opinion", "Analysis", and "Discussion" if you plan on participating on an online discussion forum where opinions and analysis are discussed and debated.

Who said that? I don't think that is clear at all, but you would know better than I.

Serious Black: Nobody is trying to solve this problem really on the federal level.

Exactly. But ACA was supposed to.

ObamaCare did do a lot on the cost control front. ACOs, the IPAB, the Center for Medicare/Medicaid Innovation, the PCORI, the co-op insurance program, the Cadillac excise tax, the minimum medical loss ratio rules...these all will have some impact on costs. It's not perfect, but then no system is.

If anyone is without healthcare for any reason then the ACA is a failure and all health insurance regulations should be scrapped.

BojanglesPaladin:But the Democrats SHOULD have a vested interest in making this thing actually work. If for no other reason than political self preservation. But for years now, they have been playing a political game of see no evil, hear no evil on ACA and doing nothing for fear of any attempts to do so being the camel's nose for the Republicans.

I just see a different reality than you. Democrats in office, and especially liberals who dominate the policy class, are all about fixing the thing. There's just nothing they can do right now while the House is controlled by the GOP. Not sure what you want them to do.

BojanglesPaladin:And the dirty little secret that Democrats can't bring themselves to face is that the ACA isn't workable, and it's only going to get worse as it unfolds. And they sold it to America with a lot of slick salesmanship and we all bought it. But it's not exactly working like it said in the brochure and now they are refusing to do the needed warranty work on it.

Oh, wait. Nevermind. I thought you were actually engaging in a policy discussion and how it intersects with the reality of Washington politics. I was mistaken.

But the Democrats SHOULD have a vested interest in making this thing actually work. If for no other reason than political self preservation. But for years now, they have been playing a political game of see no evil, hear no evil on ACA and doing nothing for fear of any attempts to do so being the camel's nose for the Republicans.

This misunderstands the long game. My belief is that it is a high stakes game of chicken. The purpose of the ACA was to move the ball enough so that there is no going back for the country. The hope is that when people see how bad the ACA actually is in practice the population will be ready to move on to single payer and not move back to the broken system.

I am not convinced that the American public will ever move on to single payer. Part of the problem for the ACA is that it has gotten attached to larger social forces that have nothing to do with health care. There is a real risk that rather than pushing people to the conclusion that single payer is the only viable option it pushes people to the conclusion that big government doesn't work. In which case not only will we not see single payer the country may wind up with something worse than what it started with.

But I do believe that the ACA was always meant to fail in the sense that it was always meant to be a stepping stone in the same way that the original confederacy of the states was a prelude to the constitutional convention and a stronger union.

If anyone is without free healthcare that I don't have to help pay for for any reason then the ACA is a failure and all health insurance regulations should be scrapped. BECAUSE THAT'S WHAT OBAMMY PROMISED

BojanglesPaladin:Serious Black: ObamaCare did do a lot on the cost control front. ACOs, the IPAB, the Center for Medicare/Medicaid Innovation, the PCORI, the co-op insurance program, the Cadillac excise tax, the minimum medical loss ratio rules...these all will have some impact on costs.

Do you have any hard numbers on this? I know there have been a lot of proposed measures and additional bureaucracy and regulations that ideally might in some way produce some potential savings, but the numbers I have seen from the CBO show us paying more than if we had done nothing and predicting rising healthcare costs per capita over the next decade or more. I have not seen any hard numbers showing a net reduction in either insurance premiums or health care costs, and minimal, if any, reduction in the RATE of growth. But I may have missed some key information.

I assume you have looked into it. What have you found that convinces you otherwise?

ACOs seem to be having a positive impact. Several have reported cost reductions so far with no negative consequences on the quality of care. The Massachusetts pilot with AQCs for BCBS is showing similar results.

Nobody has been named to the IPAB, it is only legally empowered to make cost-saving suggestions when costs exceed the target growth rate of GDP+1% (by 2019, indexed to CPI-U before then), and it can only do thinks after the beginning of 2015, so it has had no impact whatsoever.

I haven't seen much from the Center for Medicare and Medicaid Innovation, but their website suggests they are pushing a ton of pilot projects for payment reforms along the lines of bundled payments and primary care transformation. I wouldn't be surprised if a pilot all-payer system came out of them at some point.

Given its nature as an agency for comparative effectiveness research, we likely won't see much out of the PCORI for a long time. What gains we do see would almost certainly just get plowed back into spending on better care.

The only news I've heard on the co-ops is that several states have established them and are selling plan with them on their exchanges. They've been competitively priced and are often the lowest cost plans available. As we've seen, the more competitors on an exchange, the lower the average premiums are.

The Cadillac excise tax won't do anything until 2018.

The MLR rules have already resulted in giving over a billion dollars in rebates back to beneficiaries. They'll continue to either push these rebates out or will push premiums down as companies adjust to only spending 15-20% of their money on administrative expenses.

Tricky Chicken:When you say 'then pass a bill fixing the flaws', all they have to do is say 'there are too many flaws to fix, we need to repeal and start over'.

I do not disagree with you. But the point was made a couple times that we should be supporting a (non-existent, hypothetical) bill that would address this issue. To which I observed that the Democrats are not offering such a bill either, and they neglected to address it in 2010 when they amended it.

lockers:Not informing you that not all doctors on a procedure are in network sounds like fraud. How can I even vet that?

You sign paperwork to that effect in the stack of papers you sign as part of your pre-surgery release. The problem is often that NONE of certain specialties are in-network.

revrendjim:All the plans I am looking at have an absolute cap on out of pocket expenses, in my case around $6k. That would sting but wouldn't lead to bankruptcy.

The cap is for in-network providers. You can still get a bigger bill that you will have to pay.

bradkanus:I think Docs and Hospitals have to be regulated on what they can charege across the entire market - not just the government backed part.

So you are for governmental wage controls? Why do you think the government can tell one group of people how much money they can make, but not another group? Currently, all the liberals are complaining about how much the government says that low skilled people can make is not enough, they want minimum wages raised. But you say they should also lower what a highly skilled worker should be able to make, even if it doesn't compensate them for the amount of effort and time put into learning those skills? Where is the line drawn?

BojanglesPaladin:DamnYankees: But "Obamacare failed to fix this pre-existing issue which was already broken" isn't much of an argument; Obamacare isn't a panacea.

Translation: "Hey Guys! Stop expecting this huge bill to actually fix the things it's supposed to fix OK? That's just not FAIR! Just because Obama promised people wouldn't go bankrupt from medical bills anymore is no reason to expect the ACA to protect people from going broke from medical bills!!!"

I REALLY genuinely hope that y'all can keep this level of intense scrutiny fixed on the president and his agenda the next time a republican's in office.

dinomyar:revrendjim: All the plans I am looking at have an absolute cap on out of pocket expenses, in my case around $6k. That would sting but wouldn't lead to bankruptcy.

The cap is for in-network providers. You can still get a bigger bill that you will have to pay.

bradkanus: I think Docs and Hospitals have to be regulated on what they can charege across the entire market - not just the government backed part.

So you are for governmental wage controls? Why do you think the government can tell one group of people how much money they can make, but not another group? Currently, all the liberals are complaining about how much the government says that low skilled people can make is not enough, they want minimum wages raised. But you say they should also lower what a highly skilled worker should be able to make, even if it doesn't compensate them for the amount of effort and time put into learning those skills? Where is the line drawn?

Regulating what a business can charge for a given product or service ≠ governmental wage control

BeesNuts:BojanglesPaladin: DamnYankees: But "Obamacare failed to fix this pre-existing issue which was already broken" isn't much of an argument; Obamacare isn't a panacea.

Translation: "Hey Guys! Stop expecting this huge bill to actually fix the things it's supposed to fix OK? That's just not FAIR! Just because Obama promised people wouldn't go bankrupt from medical bills anymore is no reason to expect the ACA to protect people from going broke from medical bills!!!"

I REALLY genuinely hope that y'all can keep this level of intense scrutiny fixed on the president and his agenda the next time a republican's in office.

Cause that would've been really nice last time.

Could you imagine this level of scrutiny on the war in Iraq? I was promised we would be greeted as liberators. I was promised the mission was accomplished. I was promised a few weeks/months TOPS.

And here we have Republicans biatching about how sure a bill fixes SOME of the things but not ALL of the things.

Harbinger of the Doomed Rat:dinomyar: revrendjim: All the plans I am looking at have an absolute cap on out of pocket expenses, in my case around $6k. That would sting but wouldn't lead to bankruptcy.

The cap is for in-network providers. You can still get a bigger bill that you will have to pay.

bradkanus: I think Docs and Hospitals have to be regulated on what they can charege across the entire market - not just the government backed part.

So you are for governmental wage controls? Why do you think the government can tell one group of people how much money they can make, but not another group? Currently, all the liberals are complaining about how much the government says that low skilled people can make is not enough, they want minimum wages raised. But you say they should also lower what a highly skilled worker should be able to make, even if it doesn't compensate them for the amount of effort and time put into learning those skills? Where is the line drawn?

Regulating what a business can charge for a given product or service ≠ governmental wage control

No it just equals stupid. Do you think every hospital/doctors office pays the same per foot in rent/mortgage, salary and benefits, utilities, property tax, and so and and so forth to the hundreds of factors that go into charging for a service outside of profit?

EWreckedSean:Serious Black: Mandate every health care provider charge the same price to every patient regardless of their method of payment.

You're welcome.

Because that can't have any problems? Say goodbye to anybody with Medicare or Medicaid seeing a doctor again.

Who said that would necessarily be the result? Maryland's Health Services Cost Review Commission sets prices for everything, and Medicare and Medicaid are included in these rate settings. I haven't seen a mass of horror stories about patients with Medicare or Medicaid being unable to see a doctor in Maryland recently.

Can you explain how dictating what a person who provides a service can be paid for that service is not wage control? Especially when many doctors are paid per procedure performed, many doctors are independent contractors, and many doctors are sole practitioners?

Serious Black:EWreckedSean: Serious Black: Mandate every health care provider charge the same price to every patient regardless of their method of payment.

You're welcome.

Because that can't have any problems? Say goodbye to anybody with Medicare or Medicaid seeing a doctor again.

Who said that would necessarily be the result? Maryland's Health Services Cost Review Commission sets prices for everything, and Medicare and Medicaid are included in these rate settings. I haven't seen a mass of horror stories about patients with Medicare or Medicaid being unable to see a doctor in Maryland recently.

That is because Maryland has been given a Waiver from the federal law on pricing for Medicare/Medicaid that all other states have to follow.

lockers:I don't remember signing any paperwork relating to planned billing, what was in network and not, etc... Doesn't mean I didn't. It was over a decade ago.

It's part of your general release paperwork. It's the part where you agree to be responsible for the bill, regardless of whether or not insurance covers it. If insurance covers everything, you will never need worry about it. Also, most decent plans provide coverage for out of network, though the caps are much higher. Some cover out of state, etc.

The complaint is that the ACA plans DON'T include adequate coverage for stuff outside of network, like most good plans do. In the past, you could opt to get extra protection, with an ACA plan, you may be SOL. I find it hard to believe it's a big fat ZERO for out of network.

Can anyone confirm that ACA plans have ZERO coverage out of network, or is it just that they pay a portion only, and there is no limit on your OOP?

BojanglesPaladin:Harbinger of the Doomed Rat: Regulating what a business can charge for a given product or service ≠ governmental wage control

Can you explain how dictating what a person who provides a service can be paid for that service is not wage control? Especially when many doctors are paid per procedure performed, many doctors are independent contractors, and many doctors are sole practitioners?

Serious Black:EWreckedSean: Serious Black: Mandate every health care provider charge the same price to every patient regardless of their method of payment.

You're welcome.

Because that can't have any problems? Say goodbye to anybody with Medicare or Medicaid seeing a doctor again.

Who said that would necessarily be the result? Maryland's Health Services Cost Review Commission sets prices for everything, and Medicare and Medicaid are included in these rate settings. I haven't seen a mass of horror stories about patients with Medicare or Medicaid being unable to see a doctor in Maryland recently.

More detail:

"The Maryland law gave the HSCRC authority to set hospital rates for all payers. However, federal law, which takes precedence, governed the methods by which Medicare and Medicaid paid hospitals. The HSCRC believed that hospitals should operate under consistent payment incentives and that the payment methods of Medicare and Medicaid, which were cost-based at that time, were contrary to the interests of efficient hospitals arid to those of the citizens of Maryland. Therefore, the HSCRC negotiated with representatives of both Medicare arid Medicaid and, effective July 1, 1977, obtained a waiver of federal law that required Medicare and Medicaid to begin paying hospitals on the basis of HSCRC-approved rates. 3, 4 Thus, while the HSCRC has been approving hospital rates since 1974, those rates have covered all payers only since the Medicare Waiver was granted in1977. "

Serious Black:Who said that would necessarily be the result? Maryland's Health Services Cost Review Commission sets prices for everything, and Medicare and Medicaid are included in these rate settings. I haven't seen a mass of horror stories about patients with Medicare or Medicaid being unable to see a doctor in Maryland recently.

Teufelaffe:Tricky Chicken: The house won't pass anything that actually 'improves' the bill, and the Democrats don't have the seats to force anything through like they did when it passed in the first place

In other news, getting more votes than the opposition means you've "forced" a bill through.

Yes, yes it does. Especially when you have to sneak it through in the last minute as some of your people have been defeated and will be replaced soon. Oh, and you can't get any support from the other side making it an extremely partisan bill.

But you knew that already didn't you? You just wanted to help me make the point that it was forced through right?